Disclosure:
This text represents my own views and not the ones from my former or current employer(s).
Medical affairs (MA) serves as a bridge across various business units in a company and plays a crucial role to improve patient’s outcome by engaging with external stakeholders. In contrast to other business units, such as sales, the measurement of the impact of MA and their field medical (FM) personnel such as the medical science liaisons (MSLs) is still highly debated in the community as key performance indicators (KPIs) such as activity metrics are mostly adapted from commercial performance measurements that might not adequately represent the impact of MA. Although recent literature (see below) suggests a much more holistic approach to measure the impact of FM and their MSLs, this article focuses on the conundrum of how the industry is split in considering activity metrics and why it is sensible to maintain it.
As shown by a report from 2023 “Measuring the Impact of Medical Affairs”1,a survey of FM leaders elucidated a disparity between the priority of key outcome metrics that FM leaders considered important and what their team was measuring. The results show that activity metrics was the main measured KPI (35%) although FM leaders considered this KPI as one of the least relevant (6%). Moreover, the report suggests a “medical impact model” whose foundation is based on operational effectiveness to fulfill other metrics that are more HCP and patient centered. Operational effectiveness might be viewed as either to be aligned to activity metrics such as frequent contacts to ensure a certain level of impact on HCP and patients or not to be affected by frequent visits due to lack of knowledge about the exchange; a further recent report from 2024 named “Field medical impact measurement: A biopharma consensus”2 aimed to create novel Field Medical Impact Indicators (FMIIs) to assess the impact and value of FM roles. The report states that activity metrics such as frequency of contact with HCPs do not necessarily parallel the impact or even value created by MSLs (definitions of “impact” and “value” can be found in the report). Thus, MA and their MSLs need to consider other objectives of their role and functions to fulfill expectations of HCPs, patients, and even their own company.
As this view is shared by various companies, the KPIs do not always focus on this metric. MA departments of those companies might measure e.g. the generation of medical insights, advocacies of HCPs in context of speaker activity, the execution of advisory boards or regional/national meetings. However, other companies still focus on the metric of contact frequency as they might see it as necessary to visit HCPs in a frequent manner in order to spread the strategy of the medical plan in the field.
Visiting HCPs just for the sake of fulfilling specific KPIs is neither productive nor efficient to fulfill the function of the MSL. It could even be detrimental, as frequent visits without substance might lead to poor relationships with HCPs and lead to a negative reputation. In cases of already existing poor relationships with HCPs, however, frequent visits might be the vehicle to overcome a “dead-end” situation as each visit can be used to explore the needs and challenges of the HCP and the patients and offer the right tools to overcome them. Such undertaking needs to be scrutinized critically in order to be tactful and find the balance. Furthermore, a metric of contact frequency ensures activity in the field, as competitors might take advantage if they are aware of low contact frequency. Thus, MA as an entity must involve FM in the creation and provision of tools regarding the MA objectives in the company to ensure that MSLs have the requested information for the HCPs. In this step, it might become obvious that MSLs do not need to visit HCPs frequently but rather in a goal- and purpose-oriented manner as suggested by the reports mentioned above. This will not only automatically lower the contact frequency activity metric but also strengthen it contextually.
Thus, contact frequency has to be discussed with the manager and eventually updated if frequent visits are considered to be disruptive or inefficient. Despite any amendment in this metric, it is important to differentiate the influence and advocacy of any HCP. Some HCPs, in this case often referred to as key opinion leaders (KOLs), who advocate strongly for the compound of the company, might want the MSL to be at their disposal in a regular manner to discuss novel data or advocacy plans, while others do not require close interaction as they already obtain all information from their own scientific activity. Nevertheless, the MSL should still visit these KOLs as they may be able to provide important medical insights. HCPs who do not publicly advocate for the compound but use it in their treatment regimen might require high contact frequency to ensure they obtain recent scientific information from trials or congresses. However, high frequency visits may not be appropriate if the focus of the HCP does not rely on scientific engagement. In case the MSL encounters an HCP in the territory who is not willing to move from his or her treatment regimen, frequent contact might still be relevant to gain medical insights on the HCP’s treatment behavior and to clarify questions if the behavior is founded on the lack of knowledge about the compound. Such undertaking plays into the “medical impact model” of the 2023 report to affect scientific belief alignment and into the FMII suggested in the report of 2024 to determine actions taken after engagement by the HCP. It becomes clear that neither change nor impact can be accomplished without visiting the HCPs.
Thus, it is necessary to continue the measurement of activity metrics. This measurement should be considered in raw numbers to analyze a correlation between contact frequency and impact (e.g. number of visits per HCP per period of time and the execution of a certain FMII). As a correlation does not equal causality, MA departments need to implement a further step to give MSLs the opportunity to add context to their raw numbers. Such context might be in written statements or bullet points that can be summarized and analyzed by artificial intelligence using large language models. In this way, MSLs and the MA department will be able to show and communicate their value to the company and ensure trust as MSLs will continue to visit the HCPs frequently.
Acknowledgement:
I would like to thank Maja Beilmann-Schramm (Merck KGgaA, Global) for providing the references and insight exchange
References:
- “Measuring the Impact of Medical Affairs Part 1: A data-driven, modular approach”, 2024, https://www.veeva.com/medicalimpact/
- Beilmann-Schramm, Bradford, Carter, Dias, Fergusson, Fusco, Georgiou, Gerloff, Harris, Hewitson, Kane, Lowe, Macgregor, Macdonald, Medhurst, Van Melckenbeke, Patel, Quinn, Rankine, Rees-Saunders, Smith, Tainton, Tilley, Villalobos, Wan, Wilson, Zimmermann, “Field medical impact measurement: A biopharma consensus”, 2024, https://www.onemsl.com/msl-resources/
About the author:
Alex Palumbo, PhD
I am a neuroscientist by training and I am currently a medical scientific liaison manager at Teva Pharmaceuticals. I am also part of the global medical affairs committee for the organization of internal events related to medical affairs and MSLs.
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